title: Osteotomy, arthrodesis, and arthroplasty for complex multiapical deformity of the leg.
abstract: BACKGROUND
  Assessment of diaphyseal deformity in the tibia consists of delineating anatomic axes or cortical lines with resultant apices of deformity. Single-apex deformities have been well described both in terms of assessment and treatment, whereas double-level deformities with metaphyseal and/or juxtacortical involvement are less straightforward. Multiapical deformities of the lower extremity, though uncommon, are the next level of complexity and provide the surgeon with a difficult correctional mission.
  
  
  METHODS
  We report two cases of multiapical deformity of the tibia, both of which were secondary to a distant history of tibial fracture with resultant knee and ankle joint degeneration and deformity. Both cases had three levels of deformity that were addressed with tibial osteotomy, ankle fusion, and total knee replacement. Initial presentation, problem lists, surgical treatment, and subsequent results are reviewed.
  
  
  METHODS
  Treatment of a post-traumatic three-level deformity has never specifically been addressed in the literature, although the principles of treatment are the same as for less complex deformities.
  
  
  CONCLUSIONS
  These two cases present a treatment approach for complex, multiapical deformity of the tibia. The same principles of deformity correction used to treat less complex deformities are applied to these patients with an overarching synthesis that takes all aspects of the three deformities into account. Although these cases are complex and difficult, good results in terms of deformity correction and pain relief can be obtained.
authors.affiliation: University of Nebraska Medical Center, Omaha, NE 68198 USA.
authors.forename: Alex C
authors.initials: AC
authors.lastname: Lesiak
authors.forename: J Turner
authors.initials: JT
authors.lastname: Vosseller
authors.forename: S Robert
authors.initials: SR
authors.lastname: Rozbruch